STUDENT HEALTH CHECKLIST FORMAT
Student Name: [Enter Student Name]
Grade/Class: [Enter Grade/Class]
Date of Birth: [Enter Date of Birth]
Date of Checklist: [Enter Date]
Personal Health Information
Category | Details |
---|
Allergies | [Specify Allergies or Write None] |
Medications | [List Medications or Write None] |
Chronic Conditions | [Specify Chronic Conditions or Write None] |
Vaccination Status | [Up-to-date/Pending] - Specify Pending Vaccines |
Recent Illness/Injury | [Describe Recent Illness/Injury or Write None] |
Daily Health Monitoring
Health Aspect | Checked (✔) | Comments |
---|
Temperature | | [Add Temperature Reading or Notes] |
Symptoms of Illness | | [Specify Symptoms or Write None] |
Energy Levels | | [Describe Observation] |
Appetite | | [Describe Eating Habits] |
Hygiene Practices
Hygiene Aspect | Status (✔) | Comments |
---|
Regular Handwashing | | [Additional Notes] |
Personal Cleanliness | | [Describe Hygiene Habits] |
Proper Mask Usage (if needed) | | [Describe Mask Compliance] |
Physical and Mental Well-being
Aspect | Checked (✔) | Notes/Comments |
---|
Physical Activity | | [Describe Physical Activities] |
Sleep Hours (8–10 hours) | | [Specify Average Sleep Duration] |
Emotional/Mental State | | [Describe Emotional/Mental State] |
Health Appointments
Appointment Type | Date | Status |
---|
Doctor Checkup | [Enter Date] | [Completed/Pending] |
Dentist Checkup | [Enter Date] | [Completed/Pending] |
Specialist Visit | [Enter Date] | [Completed/Pending] |
Parent/Guardian Notes
Health Checklist Certification
Checklist Templates @ Template.net